D.W. is a 25-year-old married woman with three children under 5 years

Question D.W. is a 25-year-old married woman with three children under 5 yearsold. She was first seen by her physician months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time.Laboratory studies at that time revealed that D.W. had a positive antinuclear antibody (ANA) titer, positive dsDNA (positive lupus erythematosus), positive anti-Sm (anti-smooth muscle antibody), elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films demonstrated joint swelling without joint erosion.D.W. was subsequently diagnosed with systemic lupus erythematosus (SLE). She was initially treated with hydroxychloroquine (Plaquenil) 400 mg and Deltasone (Prednisone) 20 mg orally per day, bed rest, and ice packs. D.W. responded well to treatment, the steroid was tapered and discontinued, and she was told she could report for follow-up every 6 months unless her symptoms became acute. D.W. resumed her job in environmental services at a large geriatric facility.D.W. was seen in the immunology clinic twice monthly during the next 3 months. Although her condition did not worsen, her BUN and creatinine remained elevated. While at work one afternoon, D.W. begins to feel dizzy and develops a severe headache. She reported to her supervisor, who had her lie down. When D.W. started to become disoriented, her supervisor called 911, and D.W. was taken to the hospital. D.W. is admitted for probable lupus cerebritis related to acute exacerbation of her disease.Current Laboratory Test ResultsSodium 129 mmol/LPotassium 4.2 mmol/LChloride 119 mmol/LTotal CO 2 21 mmol/LBUN 34 mg/dLCreatinine 2.6 mg/dLGlucose 123 mg/dLUrinalysis 2 + protein1 + RBCs1. What is the significance of D.W.’s laboratory findings from her initial workup?2. Given that most tests are nonspecific, how is SLE diagnosed?3. What priority problems were addressed in D.W.’s care plan at that time of diagnosis?4. Which current laboratory findings concern you, and why?5. Detail D.W.’s expected treatment plan and nursing interventions. Include complications associated with immunosuppression therapy. Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

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